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Safety of the Blood Supply in the United States: Opportunities and Controversies

James P. AuBuchon, MD; John D. Birkmeyer, MD; and Michael P. Busch, MD, PhD
[+] Article, Author, and Disclosure Information

From Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Veterans Affairs Medical Center, White River Junction, Vermont; and University of California, San Francisco, California. Grant Support: In part by National Heart, Lung, and Blood Institute contract NO1-HB-47114 (Retrovirus Epidemiology Donor Study) (Dr. Busch). Requests for Reprints: James P. AuBuchon, MD, Department of Pathology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756. Current Author Addresses: Dr. AuBuchon: Department of Pathology and Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(10):904-909. doi:10.7326/0003-4819-127-10-199711150-00009
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The risk for viral transmission by transfusion has been reduced dramatically through improved techniques for selecting and testing blood donors.Initiatives to further improve the safety of the blood supply, including more stringent donor qualifications, additional testing for infectious disease markers, viral inactivation processes, and refinement of transfusion decisions, are possible. However, because the risk for viral transmission by allogeneic transfusion is already low, additional measures will have limited yield and poor cost-effectiveness. Furthermore, unexpected side effects of some of these “improvements” may reduce the safety of the blood supply by introducing new risks. Cost-effectiveness analyses of blood safety initiatives have highlighted such successes as the introduction of virus-specific assays for screening donated blood and have identified other interventions that have poor cost-effectiveness estimates. They have also quantitated the threshold level at which the risks of an intervention outweigh its benefits. These analyses have had little effect on decisions about blood safety, possibly because of overwhelming fear of AIDS and difficulties in applying cost-effectiveness estimates to a politically and emotionally charged issue. Future interventions for improving blood supply safety must be evaluated thoroughly and chosen carefully so that the intended goals are met. Communication with the public should be undertaken so that the public understands that some of the desired measures may result in inefficient allocation of health care resources.


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Figure 1.
Decrease in per-unit risk for transmission of hepatitis B virus (broken line), hepatitis C virus (dotted line), and HIV (solid line) by blood transfusion in the United States.[4]

The arrow shows the current risk for death from acute hemolysis for comparison.

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Figure 2.
Comparison of cost-effectiveness of transfusion safety interventions (striped bars) and other medical practices (white bars)[27-31]

. ALT = alanine aminotransferase; anti-HCV = antibody to hepatitis C virus; HCV = hepatitis C virus.

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